In Ogilvie's syndrome, which portion of the colon is most at risk for perforation due to distention?

• A. Cecum
• B. Ascending colon
• C. Sigmoid colon
• D. Descending colon

Answer: (D)

In Ogilvie's syndrome the danger of perforation rises with wall tension as the colon distends. The cecum has by far the largest diameter in the colon, so when distention occurs the wall tension here is greatest (LaPlace’s law: tension increases with radius). That makes the cecum the segment most likely to rupture under severe distention. Clinically, perforation risk climbs as the cecal diameter approaches around 12 cm. Other parts of the colon can distend as well, but their smaller radius and relatively thicker walls mean they’re less prone to perforation than the cecum.